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Article
MANAGEMENT OF STAPLE LINE LEAKS FOLLOWING SLEEVE GASTRECTOMY

Authors: Nasseif Jassim Mohammed --- Falih M Algazgooz
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 1 Pages: 57-62
Publisher: Basrah University جامعة البصرة

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Abstract

MANAGEMENT OF STAPLE LINE LEAKS FOLLOWING SLEEVE GASTRECTOMY Nasseif Jassim Mohammed@ & Falih M Algazgooz* @MB,ChB, CABS, FICMS, General and Laparoendoscopic Surgeon, Al-Sadr Teaching Hospital. *MB,ChB, CABS, FICMS, FACS, MRCS, Consultant Bariatric and Laparoendoscopic Surgeon, Al-Sadr Teaching Hospital, Basrah, IRAQ. Abstract Bariatric surgery is a growing specialty and the number of laparoscopic sleeve gastrectomies (LSG) has increased dramatically in the latest years all over the world. Gastric leak is considered one of the most serious complications following laparoscopic sleeve gastrectomy, it can become chronic, recurrent, and need multiple interferences. The purpose of the present study is to determine the clinical presentation of gastric leak after LSG, its management, postoperative course, and to show the effectiveness of various ways of managing such complication. This study included 200 patients who underwent sleeve gastrectomy at Al-Sadr Teaching Hospital for morbid obesity, they were 60 males(30%) and 140 females(70%). The mean age was 35 years and the mean body mass index (BMI) was 39 kg/m2. Out of the 200 patients who underwent laparoscopic sleeve gastrectomy, 6 patients (3%) were recognized to have leak complication. All leaks were proximal and identified at the gastroesophageal junction. Management was accomplished by putting T tube at the site of leak for 2 patients, direct closure for one patient, just drainage for one patient, and Roux-en-Y Gastric Bypass (RYGB) for the remaining 2 patients. In conclusion, prompt diagnosis and treatment is vital in the management of a leak. However, it can be treated securely via numerous management ways depending on the time of diagnosis and magnitude of the leakage.


Article
Early Experience of Metabolic Surgery

Author: Muthanna A.Al-Sharbaty,Yasser F.Zidan ,Samir I. Al-Saffar , Israa I.Mohammed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 169-173
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Laparoscopic sleeve gastrectomy LSG is known to be a highly effective treatment for morbid obesity and many related conditions including type 2 diabetes mellitus (T2DM) and the metabolic syndrome.OBJECTIVE: To assess the effectiveness of (LSG) on glucose homeostasis in morbidly obese diabetic patients and it shows early experience of metabolic surgery.METHODS: Prospective clinical case series study conducted in Al-Jumhoori Teaching Hospital and involved 20 patients (17 females and 3 males); their age (22-54 average 37 years) underwent LSG and the level of glucose evaluated at different times by measuring fasting blood glucose level, glycosylated hemoglobin (HbA1C).RESULTS: The initial body weight 70-142(110Kg); BMI 31.8-53.9 (45.16Kg/m2); two patients with diabetes mellitus and BMI less than 35Kg/m2 involved.The mean level of fasting blood glucose assessed and found to be (202,165,130,107,96 mg/dl) in preoperative ,one-day postoperative,10 days, three and six-months interval; while the level of HbA1C were( 10.2,9,7.2,6.1) in the preoperative ,10 days,3 and 6 months interval respectively.CONCLUSION: LSG is an effective procedure to decrease weight for morbid obesity and it resolve T2DM in 90% while improvement of T2DM occurred in 10 % so LSG is an effective procedure to treat T2DM and the level of glucose declined significantly started from early postoperative and continued till 6 months. .


Article
Preliminary Experience of Sleeve Gastrectomy

Author: Muthanna A.Al-Sharbaty ,Yasser F.Zidan ,Samir I. Al-Saffar , Israa I.Mohammed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 3 Pages: 350-353
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Laparoscopic Sleeve gastrectomy (LSG) is the most common restrictive procedure performed worldwide for treatment of morbid obesity.OBJECTIVE: To assess the safety, effectiveness and complications of LSG performed for Iraqi patients and shows early experience of LSG.METHODS: Prospective clinical case series study conducted in Al-Jumhoori Teaching Hospital and involved 70 patients (57 females and 13 males);their age (19-59 average 37 years) underwent LSG(6 open ,64 laparoscopically with one conversion);51 patients finish 1 year follow up .RESULTS: The initial body weight 70-195(122Kg); BMI 31.8-65.9 (50.16Kg/m2); two patients with diabetes mellitus and BMI less than 35Kg/m2 involved.The average weight loss assessed and found to be (13.85, 32.8, 40.8 and 48.3 Kg) in 1st, 3rd, 6th and 12th month interval; The BMI reduced from 50.16 to 35.43 and 29.52 at 6th and 12th months.We recorded 1 mortality after 10 days (massive pulmonary embolism), 1 case converted to open and minigastric bypass due to narrowing of the sleeve part.The associated comorbidities improved after weight loss, and the quality of life improved in 88% of patients depending on bariatric analysis and reporting outcome systems (BAROS).CONCLUSION: Sleeve gastrectomy is relatively safe and effective procedure to decrease weight for morbid obesity and it improves the quality of life, but all bariatric procedures needs good health resources and settled countries which were not present in Iraq for the time being.


Article
Laparoscopic Sleeve Gastrectomy In Morbid Obesity: Early Results Of 240 Patients
النتائج الاولية لمئتان واربعون مريضا خضوا لعلمية قص وتكميم المعدة بالناظور والذين يعانون من السمنة المفرطة

Author: Ramiz Al-Mukhtar رامز المختار
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2014 Volume: 56 Issue: 1 Pages: 1-4
Publisher: Baghdad University جامعة بغداد

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Background: Laparoscopic sleeve gastrectomy is becoming one of the most common procedures performed for the treatment of morbidly obese patients in the last few years until now.Objectives: This type of surgery needs to be evaluated regarding the various techniques used and the possible post-operative complications with the exact methods of treating them.Patients and methods: A retrospective study was conducted on 240 consecutive morbidly obese patients over a period of 3 years (Feb 2011- Mar 2013) in the Saint Raphael Centre of morbid obesity with an average patient body mass index of 45 (35 - 61). They all underwent LSG, and the decreased weight resulting from surgery was analyzed regarding early and late complications. In 40 of the 240 patients, the gastric band was removed 4 weeks prior to the sleeve operation. Results: Intraoperative difficulties (difficult endotracheal intubation in 7 patients, difficult ports insertion in 6 patients, opening of the staple line in one patient and a bleeding from short gastric vessels in 2 patients). Only 5 patients developed primary haemorrhages (within the first 24 hours post operatively) from the staple line three of them were treated conservatively and the other 2 patients were returned to the theater, no anastomotic leakage or stricture, and no mortality.During a median follow up of 10.6 months (range of 1-3 months), the excess BMI lost reached 52+-23%, and the BMI decreased from 45 +-5 to 33 +- 5 kg/m2. Patient satisfaction scores (1-4) at least one year after surgery was 3.5 +- 0.7.Conclusion: The early results achieved by following the above outlined surgical steps in 240 consecutive patients who underwent LSG indicates show that this type of morbid obesity surgery is an effective, safe and worthwhile choice for morbidly obese patients as a first treatment option, although long-term results are still pending.Keywords: sleeve gastrectomy, morbid obesity.

الخلاصة: عملية قص وتكميم المعدة بالناظور باتت واحدة من العمليات الأكثر شيوعا التي تجرى لعلاج مرضى السمنة المفرطة في السنوات الاخيرة .الهدف من الدراسة :هذا النوع من الجراحة يحتاج إلى تقييم فيما يتعلق بمختلف التقنيات المستخدمة و المضاعفات المحتملة بعد العملية الجراحية وطرق علاجها أجريت دراسة بأثر رجعي على 240 مريض يعانون من البدانة المفرطة على مدى 3 سنوات (من شباط 2011 – الى اذار 2013 ) في مركز القديس رافاييل للسمنة المفرطة بمتوسط مؤشر كتلة الجسم 45 ( 35-61 ) جميع المرضى خضعوا لعملية قص وتكميم المعدة بالناظور ، تمت دراسة انخفاض الوزن الناتج من العملية ومراجعة المضاعفات المبكرة والمتأخرة اربعون من 240 مريضا ، تم إزالة حلقة المعدة قبل اجراء عملية تكميم و قص المعدة.النتائج: مواجهة صعوبات أثناء العملية في 16 مريضا خمسة مرضى عانوا من نزف بعد العملية خلال الاربع وعشرون ساعة الاولية ، ثلاثة منهم عولجوا تحفظيا واثنان اعيدوا الى صالة العمليات ، لا تسرب توصيلي أو تضيق ، وبلا وفيات .خلال متوسط متابعة 10.6 شهرا ( مجموعة من 1-3 أشهر)، و مؤشر كتلة الجسم الزائدة فقدت وصلت 52 + -23٪ ، و انخفض مؤشر كتلة الجسم من 45 إلى 33 + -5 + - 5 كغمم2 . درجة رضا المرضى بلغت من (1-4 ) بعد سنة واحدة على الأقل من الجراحة 3.5 + - 0.7. النتائج الاولية لمئتان واربعون مريضا الذين خضعوا لعملية قص وتكميم المعدة بالناظور تشير إلى أن هذا النوع من جراحة السمنة المفرطة هو خيار فعال وآمن وجدير بالاهتمام لمرضى السمنة المفرطة كخيار علاجي أول ، على الرغم من أن النتائج على المدى الطويل لا تزال معلقة .مفتاح الكلمات: سمنة مفرطة قص وتكميم المعدة


Article
Surgical management of staple line leak after laparoscopic sleeve gastrectomy

Authors: Mohammed Q.AbdulJabbar محمد قاسم عبد الجبار --- Ramiz S. Mukhtar د. رامز المختار
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2017 Volume: 59 Issue: 1 Pages: 1-4
Publisher: Baghdad University جامعة بغداد

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Background: Laparoscopic sleeve gastrectomy (LSG)is derived from the biliopancreatic diversion with duodenal switch operation(BPD-DS). Specific and potentially severe complications of LSG are bleeding from the staple line and staple line leakage (SLL). A staple line leak may result in severe morbidity with potential sepsis and multi- organ failure.Objectives: To review our experience with the definitive surgical management of staple line leak Post sleeve gastrectomy and its outcomes.Patients and methods: retrospective review of patients who underwent definitive surgical treatment of staple line leak post sleeve gastrectomy from May 2014 till June 2016 at Saint Raphael center of morbid obesity, Primary surgery was laparoscopic sleeve gastrectomy in all patients. Staple line leak was diagnosed at the gastroesophageal junction in all patients.Results: Six female patients were treated with definitive surgical management, mean body mass index was 42.7±4.0(range from 35.3-51.2 kg/m2 ), all patient had no associated co-morbidities related to obesity, the mean age of the patients was 36(range from 29-43 years), The leak was at the Gastroesophageal junction in all patients.All patients were fully recovered after definitive surgical treatment of leak, no signs of persist leak during the follow up period, with no mortalityConclusions: Definitive surgical repair with conversion to Roux-en-Y gastric bypass, is safe and very effective and should be done when the general condition of the patient is optimized whenever possible.


Article
Evaluation of Predisposing Risk Factors for Gallstone Formation Following Bariatric Surgery

Author: Haider Abdul Hussein Ahmed*, Zaid Zuhair Abdulsahib**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 4 Pages: 335-339
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:The risk factors for development of gallstones have been studied extensively in the generalpopulation. They are different when it comes to patients who underwent bariatric operations.Obesity and rapid weight loss induced by weight-reducing surgery are well recognized for thedevelopment of gallbladder stones. There is no standard policy whether to perform prophylacticcholecystectomy at the time of the bariatric operation or to give postoperative treatment to decreasethe risk.OBJECTIVE:The aim of the study is to evaluate the predictors of gallstone formation post-Bariatric surgery andassociated risk factors. The implication behind it will help decide how to follow up postoperativelyand whom are at increased risk to develop cholelithasis.METHODS:This prospective study was performed on 100 patients who underwent weight-reducing operationsat Al-Imamain Al-Kadimiyen Teaching Hospital. They were followed for 12 monthspostoperatively. Ultrasonography examination was done for those who developed symptomssuggestive of gallstone formation.RESULTS:Twenty percent of them were found to have gallstones. Of the the parameters enrolled in the study(age, gender, type of surgery, preoperative body mass index, percentage of excess body weightloss), only the factor of the percentage of excess weight loss was the most significant of predictingdevelopment of gallstone post-bariatric procedures (p value = 0.002). The preoperative BMI, age,gender and type of operation were found were not found to be statistically significant in terms of itsrelationship with gallstone formation.CONCLUSION :Concomitant cholecystectomy along with the bariatric procedure is not recommended. Surveillanceby ultrasonography for those with excess weight loss more than 25% of their original weight isadvised for 1 year postoperatively.


Article
Effect of laparoscopic sleeve gastrectomy on blood sugar and blood pressure

Authors: Rida J.Al-Basri*, --- Ali H. Mutar**, --- Ali M. Tali+, --- Sudad M. Salih***
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2019 Volume: 15 Issue: 1 Pages: 95-102
Publisher: Baghdad University جامعة بغداد

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Background: Surgery is one and may be the most effective method to treat obesity. In the last decade, Laparoscopic Sleeve Gastrectomy is perceived to be less invasive, technically simple, less morbid and more popular form of bariatric surgery.Objectives: This study aims to assess the effect of Laparoscopic Sleeve Gastrectomy on Fasting Blood Glucose Levels and Blood Pressure. Methods: A prospective controlled study in which 50 obese patients were involved, 36 of patients have hypertension and type 2 diabetes mellitus , 7 patients have type 2 diabetes mellitus only, and 7 patients don’t have hypertension or type 2 diabetes. All patients were submitted to Laparoscopic Sleeve Gastrectomy at Al-Kindy Teaching Hospital between October 2014 and October 2016.Results: Forty five of patients were females, while five were males . Mean age was 34 years, mean height 159 cm mean pre Laparoscopic Sleeve Gastrectomy weight was 121kg. Mean post- Laparoscopic Sleeve Gastrectomy weight was 82kg. Mean weight loss outcome at 1 year follow-up is 32.23% of total body weight. . Preoperative initial mean value of fasting blood glucose was 157.4 mg/dL and the declining occurred at 12 months after Laparoscopic Sleeve Gastrectomy was 97 mg/dL . The hypertension remission rates 1 year after Laparoscopic Sleeve Gastrectomy ranges up to 54% of total number of patients and 75% of those with Hypertension. Conclusions: Laparoscopic Sleeve Gastrectomy has an effect in improving Fasting Blood Glucose Levels and Blood Pressure.Key words: Obesity, Laparoscopic Sleeve Gastrectomy Type 2 Diabetes Mellitus, Hypertension . * Corresponding Author: Consultant Surgeon, RJ Al-Basri Department of General Surgery, Al-Kindi Teaching Hospital.


Article
Prospective Study of Sleeve Gastrectomy in Baghdad Teaching Hospital
دراسة مسبقة لنتائج عملية تكميم المعدة في مستشفى بغداد التعليمي

Authors: Haider Alzubaidi حيدر الزبيدي --- Ahmed S. Ahmed احمد صالح احمد --- Hamid D. Salman حامد داوود سلمان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2014 Volume: 56 Issue: 2 Pages: 132-135
Publisher: Baghdad University جامعة بغداد

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Background: obesity is a common disease affecting more than 300 million adults worldwide. Laparoscopic sleeve gastrectomy (LSG) is a relatively new and effective procedure for weight loss, it is gaining acceptance among bariatric surgeons as a viable option for treating morbidly obese patients. We describe results of our experience with LSG in a community practice.Objective: We aimed to evaluate our experience with LSG with regard to its safety and feasibility and early weight loss.Methods: prospective study done in Baghdad Teaching Hospital between February 2011 and November 2013, of 50 consecutive morbidly obese patients and was designed to study the efficacy and safety of the sleeve gastrectomy in this group of patients.Results: The mean preoperative weight of the patients was 113.4 (range 91.0–170.0) kg, while the mean BMI was 42.6 (range 33.0– 60.0) kg/m2. Hypertension was present in 34%; hyperlipidaemia in 32% and Diabetes mellitus in 8% of the patients. The majority of patients had two or more obesity-related comorbidities (52 %). Mean operative time was 142 minutes and duration of postoperative stay was three to nine days. At two weeks, one, three and six months post operation, the mean BMI was 38.6 kg/m2, 37.8 kg/m2, 34.5 kg/m2 and 30.8 kg/m2, the mean percentage of excess weight loss was 17.7 %, 23.3 %, 40.9 % and 56.7 %, and absolute weight loss was 8.00 kg, 11.52 kg, 18.77 kg and 26.85 kg, respectively.Conclusion: LSG is a promising procedure for surgical treatment of obesity, with good early weight loss and low morbidity.Keywords: sleeve gastrectomy, morbid obesity, body mass index

خلفية البحث: السمنة مرض شائع يؤثر على اكثر من 300 مليون بالغ حول العالم. عملية تكميم المعدة باستعمال الناظور هي طريقة مؤثرة وحديثة لانقاص الوزن , وقد بدأت بالانتشار بصورة واسعة بين اطباء جراحة السمنة كخيار حيوي لانقاص الوزن .الهدف : تقييم تجربتنا في عملية تكميم المعدة من حيث سلامتها ومضاعفاتها وسرعة انزال الوزن.الطريقة: دراسة تمت في مستشفى بغداد التعليمي في الفترة من شباط 2011 الى تشرين الثاني 2013 على خمسين مريض مصابين بالسمنة المفرطة اجريت لهم عملية تكميم المعدة بالناظور ومتابعة نتائجها على المرضى.النتائج: معدل وزن المرضى قبل العملية كان 113.4 كغم (يتراوح بين 91 الى 170 كغم) فيما كان معدل كتلة الجسم هو 42.6 (يتراوح من 33 الى 60 ) كغم / متر2 , ارتفاع ضغط الدم الشرياني كان الاكثر شيوعا بين المرضى بنسبة 34% من المرضى قبل العملية , معدل وقت العملية كان 142 دقيقة فيما كان بقاء المرضى في المستشفى هو بين 3 الى 9 ايام بعد العملية, في اول اسبوعين و الشهر الاول والثالث والسادس بعد العملية كان معدل كتلة الجسم هو 38.6, 37.8 , 34.5 و 30.8 على التوالي, فيما كانت النسبة المئوية لنزول الوزن هي 17.7% , 23.3%, 40.9% و 56.7% على التوالي, فيما كان فقدان الوزن المطلق هو 8 , 11.52 , 18,77و 26.85 كغم على التوالي.الاستنتاج : عملية تكميم المعدة باستخدام الناظور كخيار لعلاج السمنة المفرطة هو خيار جيد وكفوء وقليل المضاعفات .مفتاح الكلمات: السمنة المفرطة, تكميم المعدة بالناظور , معدل كتلة الجسم


Article
Comparative study of two different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy
دراسة مقارنة بن اثنين من تقنيات عملية قص وتكميم المعدة بالناظور للحد من التسرب والنزف

Author: Ramiz S. Mukhtar د. رامز المختار
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2016 Volume: 58 Issue: 2 Pages: 104-108
Publisher: Baghdad University جامعة بغداد

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Abstract:Background: Laparoscopic sleeve gastrectomy has gained more popularity as an independent bariatric procedure because laparoscopic sleeve gastrectomy was reported to be an effective, safe, and time-saving procedure, leading to adequate weight loss for morbidly obese patients and becoming one of the most common procedures performed for the treatment of morbidly obese patients in the last few years until now.Objectives: The aim of this study is to compare two different techniques of the reinforcement of staple line during LSG in the reduction of major complications (bleeding and leak).Patients and methods: prospective randomized study of a consecutive series of 126 patients that underwent LSG between April 2014 till August 2015. Patients were randomly enrolled in two different techniques of reinforcing the staple line during LSG, Group A consisted of 63 patients that underwent sleeve gastrectomy using Ethicon Endo GIA stapleTM with staple line oversewn using 2.0 prolene continuous suture, group B also 63 patients who had the staple-line oversewn with a continuous suture using V-locTM and Covidien Endo GIA tristapleTM.Results: 126 patients who underwent LSG, 82(65%) were women and 44(35%) were men. Median age was 36 years (range, 19–58 years) and median preoperative BMI was 45.4 kg/m2 (range, 37–62 kg/m2), Three patients (4.76%)from group (A) and 2 patients (3.17%)from group (B)developed primary hemorrhage (within the first 24 hours post operatively), overall bleeding rate in both groups was (3.96%), no leak in both groups and no mortality. Conclusion: laparoscopic sleeve gastrectomy is a safe procedure as a sole weight reduction operation. The combination of meticulous surgical technique, reinforcement of the gastric staple line, lead to decrease the incidence of staple line leak whatever the suture material or stapler type used, but there is no significant decrease in the incidence of bleeding with staple line reinforcement.Keywords: sleeve gastrectomy, staple line reinforcement, leak, bleeding.

دراسة مقارنة بن اثنين من تقنيات عملية قص وتكميم المعدة بالناظور للحد من التسرب والنزفالخلاصة: عملية قَص وتكميم المعدة بالناظور اصبحت العملية الأكثر شيوعا لعلاج السمنة المفرطة وذلك لثبوت فعاليتها وسلامتها وتؤدي الى فقدان الوزن بصورة فعالة للمرضى الذين يعانون من السمنة المفرطة.الهدف من هذه الدراسة: تهدف هذه الدراسة لمقارنة التقنيات المخلتفة لتعزيز خط التيلة خلال عملية قَص وتكميم المعدة بالناظور في الحد من المضاعفات الرئيسية (نزيف وتسرب)الطرق: دراسة تقدمية مكونه من ١٢٦ مريض خضعوا لعملية قَص وتكميم المعدة بالناظور للفترة من نيسان ٢٠١٤ وحتى آب ٢٠١٥,المرضى قسموا الى مجموعتين بصورة عشوائية الاولى مكونه من ٦٣ مريضا والذين خضعوا لعملية قَص وتكميم المعدة بالناظور باستخدام Ethicon Endo GIA stapleTM مع تقوية خط التيلة باستخدام خيط البرولين ٢,٠ المجموعة الثانية ايضا مكونة من ٦٣ مريض اجريت لهم عملية قَص وتكميم المعدة بواسطة Covidien Endo GIA tristapleTM. مع تقوية خط التيلة باستخدام خيط ال v-loc TMالنتائج:١٢٦ مريضا خضعوا لعملية قَص وتكميم المعدة بالناظور, ٨٢(٦٥٪) أنثى و٤٤ (٣٥٪)ذكر, متوسط العمر ٣٦ عاما (١٩-٥٨ سنة) ,متوسط كتلة الجسم قبل الجراحة هو ٤٥.٤كغم/م٢, ثلاثة مرضى من المجموعة الاولى (٤.٧٦٪‏) و مريضان من المجموعة الثانية( ٣.١٧٪‏) عانوا من نزف خلال اول اربع وعشرون ساعة بعد العملية, لايوجد اي تسرب او اي وفيات في كلتا المجموعتين.الاستتناج: عملية قَص وتكميم المعدة بالناظور, هي اجراء أمن, الجمع بين التقنية الجراحية الدقيقة وتعزيز خط التلية تؤدي الى تقليل تسرب خط التيلة مهما كانت نوع الدباسة او نوع الخيط المستخدم لتقوية خط التيلة ولكن ليس هنالك انخفاض كبير في حدوث النزيف مع تعزيز او تقوية خط التيلة.مفتاح الكلمات: قَص وتكميم المعدة,تقوية خط التيلة, تسرب, نزف


Article
The prevalence of gallstone disease after sleeve gastrectomy and Roux en Y gastric bypass
حدوث حصاة المرارة عند المرضى الذين خضعوا لعملية قص وتكميم المعدة وعملية نحوير مسار المعدة

Authors: Mohammed Q. AbdulJabbar د. محمد قاسم عبد الجبار --- Adil K. Saloom د. عادل كامل سلوم --- Ramiz S. Mukhtar د. رامز المختار
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2016 Volume: 58 Issue: 4 Pages: 316-319
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Obesity (body mass index >30) is increasing worldwide with an estimated 1.7 billion people currently affected by the disease, Gallstone represent the third most common disease observed among obese patients. Moreover about 30% of the patients who are candidates for bariatric surgery either have undergone a prior cholecystectomy or are found to present gallstones at time of surgery, On the other hand, newly formed gallstones may be diagnosed in 27% to 43% of patients who have undergone bariatric surgery within a very short period of time.Objective: To determine the prevalence of gallstone disease requiring cholecystectomy after laparoscopic sleeve gastrectomy and roux en Y gastric bypass during a one year follow up and to determine the need for prophylactic cholecystectomy in these patients.Patients and methods: prospective study among patients with morbid obesity treated with laparoscopic sleeve gastrectomy and Roux- en- Y Gastric Bypass between 1st of February 2013 till 31st of July 2015 at Saint Raphael hospital and Al-Hayat private hospital, patients with negative abdominal ultrasound preoperatively, patient with at least one year follow up after surgery were included in this study, The patients were divided into two groups for comparison. Group A patients who had laparoscopic sleeve gastrectomy, and group B included the patients who underwent laparoscopic Roux en Y gastric bypass. The primary outcome measure was the formation of symptomatic gallstones or sludge with or without complications.Results: 284 patients in group A(sleeve) and 45 patients in group B(Bypass) were included in the analysis, the mean age of was 34.5 years for group A, and 191(67.3%) of the patients were women, whereas it was 41.5 years for group B and 33 (73.3%) of the patients were women, Symptomatic cholelithiasis subsequently requiring cholecystectomy occurred in 29 (10.2%) of 284 laparoscopic sleeve gastrectomy patients, and 5(11.1%) of 45 Roux en Y gastric bypass patients , symptomatic gallstone developed in a median of 7 months in group A, while the median time to developed symptomatic gallstone in group B was 8 months. No significant difference in symptomatic gallstone disease was found between the patients who underwent laparoscopic gastric bypass and those who had sleeve gastrectomyConclusions: Cholelithiasis was common in our patients before weight reduction surgery. The rate for symptomatic gallstones after surgery was not so high.. Routine prophylactic cholecystectomy should not be recommended for these patients.

خلفية: السمنةآخذت في الازدياد في جميع أنحاء العالم بحيث ما يقدر بنحو ١.٧ مليار شخص يعانون حاليا من السمنة، حصاة المرارة تمثل المرض الثالث الأكثر شيوعا لدى المرضى الذين يعانون من السمنة المفرطة. وعلاوة على ذلك حوالي ٣٠٪ من المرضى المرشحين لجراحة البدانة إما خضعوا لجراحة استئصال المرارة بالسابق أو شخصوا بوجود حصاة المرارة اثناء التقييم قبل عملية جراحة البدانة.الهدف من الدراسة: تهدف هذه الدراسة إلى تحديد مدى حدوث حصاة المرارة بعد اجراء عملية قَص وتكميم المعدة و عملية تحوير مسار المعدةالمرضى والطرق: دراسة مستقبلية بين المرضى الذين يعانون من السمنة المفرطة والذين اجريت لهم عملية قَص وتكميم المعدة او عملية تحوير مسار المعدة بالمنظار، تم تقسيم المرضى إلى مجموعتين للمقارنة. المجموعة (أ) المرضى الذين خضعوا لعملية تكميم المعدة بالمنظار، وتضمنت المجموعة (ب) المرضى الذين خضعوا لعملية تحوير مسار المعدة بالمنظار. والنتيجة الأولية للدارسة هو تكوين حصاة المرارة عند المجموعتين خلال فترة المتابعة الدورية .النتائج: ٢٨٤ مريض من المجموعة (أ) و ٤٥ مريض من المجموعة (ب) قد أدرجوا في الدراسة، وكان متوسط العمر ٣٤.٥ عن المجموعة (أ)، و ١٩١ (٦٧.٣٪) من المرضى هم من النساء، في حين كان متوسط العمر في المجموعة الثانية هو ٤١.٥ و٣٣ (٧٣.3٪) من المرضى هم من النساء، حصاة المرارة تكونت في ٢٩ (١٠.2٪) من ٢٨٤ مريض من المجموعة الاولى ، و ٥ (١١.1٪) من ٤٥ مريض في المجموعة الثانية.الاستنتاجات: لا يوجد فرق كبير في تكوين حصاة المرارة بين المرضى الذين خضعوا لتحوير مسار المعدة بالمنظار وأولئك الذين خضعوا لقص وتكميم المعدة. ولذلك لا نوصي بإجراء استئصال المرارة الوقائي لهؤلاء المرضى.كلمات البحث: قص وتكميم المعدة ، تحوير مسار المعدة،حصاة المرارة.

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